Improving the Detection of Hypertension and its Control

改善高血压的检测及其控制

• 批准号: 10573169
• 负责人: Kristi Reynolds
• 金额: $ 208.83万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10573169
• 关键词: Adult; Age; Albumins; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Asian; Black race; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Creatinine; Data; Detection; Devices; Diagnosis; Diastolic blood pressure; Echocardiography; Elderly; Enrollment; Ethnic Origin; Ethnic Population; Guidelines; Health; Hispanic; Home Blood Pressure Monitoring; Hour; Hypertension; Individual; Left Ventricular Mass; Los Angeles; Measurement; Measures; Medical; Methods; Minority; New York; Not Hispanic or Latino; Office Visits; Organ; Outcome; Participant; Pharmaceutical Preparations; Public Health; Race; Randomized; Recommendation; Reference Standards; Reporting; Reproducibility; Research Design; Risk Factors; Sampling; Site; Testing; Visit; Woman; age difference; age group; awake; biomarker validation; blood pressure control; disability-adjusted life years; hypertension control; hypertensive; improved; indexing; modifiable risk; primary outcome; screening; secondary outcome; sex; urinary; years of life lost; young adult

Blood pressure (BP) measured in the office is used to diagnose hypertension and guide BP management for adults taking antihypertensive medication. Guidelines recommend measuring BP outside of the office using ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) to confirm office BP, averaged across multiple visits. The evidence supporting this recommendation is weak since most prior studies compared BP on ABPM or HBPM against office BP measured at a single visit. Guidelines also recommend that ABPM be performed over a 24-hour period and HBPM be based on 2 measurements in the morning (AM) and 2 measurements in the evening (PM) for 7 days. Many guidelines endorse ABPM as the reference standard for out-of-office BP monitoring, but there are few data comparing ABPM to HBPM conducted for 7 days. We recently completed a study of 400 adults that compared BP measured during 3 office visits, on ABPM, and HBPM, each conducted following guideline-recommended approaches. The study found (1) BP on HBPM was associated with left ventricular mass index (LVMI), a marker of target end-organ damage, independent of office BP and BP on ABPM, (2) office BP and BP on ABPM were not associated with LVMI, independent of BP on HBPM, (3) HBPM was more reliable (i.e. reproducible) than ABPM and office BP, and (4) office BP was more reliable than ABPM. These results suggest a new paradigm that HBPM is superior to ABPM and office BP, and ABPM is not needed when office BP and HBPM are both performed. However, no one in this study was taking antihypertensive medication, few older adults were enrolled, and a minority had high office BP. These findings need to be tested in a larger study with broader generalizability. We propose to enroll 1,696 adults in New York, NY, Birmingham, AL, and Los Angeles, CA with screening systolic/diastolic BP <160/100 mm Hg; 50% of whom will be taking antihypertensive medication. The sample will be diverse based on age (33% in each age group: 18-39, 40-59, and ≥60 years), sex (50% women), race/ethnicity (≥25% non-Hispanic white, ≥25% non-Hispanic Black, ≥25% Hispanic, and ≥10% Asian), and office BP level (50% with office BP ≥130/80 mm Hg). Office BP will be measured at 3 visits. ABPM will be performed over two 24-hour periods and HBPM will be performed with 2 AM and 2 PM measurements per day over two 7-day periods. Two markers of target end-organ damage – LVMI on echocardiogram and albumin-to-creatinine ratio – will be assessed. We will determine whether BP on HBPM is more strongly associated with target end-organ damage than office BP and awake BP on ABPM (Primary Aim 1). We will determine if HBPM is more reliable than office BP and awake BP on ABPM (Primary Aim 2). We will also determine whether the findings are consistent using asleep BP and 24-hour BP instead of awake BP, and investigate potential differences among age, sex, and race/ethnicity subgroups (Secondary Aims). The study will determine the best approach to measure BP for diagnosing and managing hypertension, which has the potential to improve the health of millions of US adults.

在办公室测量的血压 (BP) 用于诊断高血压并指导血压管理 服用抗高血压药物的成年人。指南建议在办公室外使用以下方法测量血压 动态血压监测 (ABPM) 或家庭血压监测 (HBPM) 以确认办公室血压，平均血压 多次访问。支持这一建议的证据很薄弱，因为大多数先前的研究都比较了血压 将 ABPM 或 HBPM 与单次就诊时测量的办公室血压进行比较。指南还建议 ABPM 在 24 小时内进行，HBPM 基于早上 (AM) 的 2 次测量和 2 连续 7 天晚上 (PM) 进行测量。许多指南认可 ABPM 作为诊断的参考标准 门诊血压监测，但 7 天的 ABPM 与 HBPM 比较数据很少。我们 最近完成了一项针对 400 名成年人的研究，比较了 3 次就诊期间测量的血压、动态血压监测 (ABPM) 和 HBPM，每个项目都按照指南推荐的方法进行。研究发现 (1) HBPM 上的 BP 与左心室质量指数 (LVMI) 相关，左心室质量指数是目标终末器官损伤的标志，与办公室无关 BP 和 ABPM 上的血压，(2) 办公室血压和 ABPM 上的血压与 LVMI 无关，独立于 BP 上的血压 HBPM，(3) HBPM 比 ABPM 和办公室血压更可靠（即可重复），并且 (4) 办公室血压更可靠 比 ABPM 更可靠。这些结果表明 HBPM 优于 ABPM 和 Office 的新范式 当办公室血压和 HBPM 同时进行时，不需要 BP 和 ABPM。然而，这一过程中没有人 研究正在服用抗高血压药物，很少有老年人参加，少数人担任高级职务 血压。这些发现需要在具有更广泛普遍性的更大规模的研究中进行检验。我们建议报名 1,696 纽约州纽约市、阿拉巴马州伯明翰和加利福尼亚州洛杉矶的成年人，筛查收缩压/舒张压 <160/100 毫米汞柱；其中 50% 将服用抗高血压药物。样本将根据年龄而多样化 （每个年龄组中 33%：18-39 岁、40-59 岁和 ≥60 岁）、性别（50% 女性）、种族/民族（≥25% 非西班牙裔） 白人、≥25% 非西班牙裔黑人、≥25% 西班牙裔和 ≥10% 亚裔）和办公室血压水平（50% 办公室血压 ≥130/80 毫米汞柱）。将在 3 次就诊时测量办公室血压。 ABPM 将在两个 24 小时内进行，并且 HBPM 将在两个 7 天的时间段内每天上午 2 点和下午 2 点进行测量。两个标记 将评估目标终末器官损伤——超声心动图上的 LVMI 和白蛋白肌酐比值。我们 将确定 HBPM 上的血压是否比办公室血压与目标终末器官损伤的相关性更强 以及 ABPM 上的清醒血压（主要目标 1）。我们将确定 HBPM 是否比办公室 BP 更可靠，并且 ABPM 上的清醒血压（主要目标 2）。我们还将使用睡眠来确定研究结果是否一致 血压和 24 小时血压而不是清醒血压，并调查年龄、性别和血压之间的潜在差异 种族/民族亚群体（次要目标）。该研究将确定测量血压的最佳方法 诊断和管理高血压，有可能改善数百万美国成年人的健康。